Very Specific ? Regarding Care Plans...I promise

[RNfromMN, BSN, RN]

i'm doing a care plan for a community. to be more specific, the elderly population of a certain community. the nursing diagnosis i've come up with for this community is:

social isolation related to conditions associated with aging (including depression, dementia, hearing loss & incontinence) as manifested by the existence of a senior subculture (apartment complex).

my outcome is:

elderly population within this community will participate in activities and programs within their community.

my question is: since this is a careplan that addresses a community, do you think i still need to include a time frame with my outcome (i.e. elderly population will participate in activities at least once a week.)

thank you in advance for your help :thankya:

[athena55, BSN, RN]

Hello Jessica392:

Gosh, it has been a number of years since I really wrote out a care plan. Umm, one problem that I see with the nursing diagnosis: Are you saying that all the residents of that particular long term care facility or nursing home are socially isolated? Do you have actual numbers to back that up (how many of the residents are clinically depressed or self report such, additionally how many have signs and symptoms of dementia, have hearing loss, and are incontient? ) Perhaps you might state it as Potential for social isolation R/T common conditions associated with the aging process AEB _______

Sorry, I digress. Yes, I certainly agree that you need to state a time frame

I am hoping that someone else on this forum can assist you in a much better way than I. Good Luck!

Respectfully

athena

[RNfromMN, BSN, RN]

Aha! Yes, potential/at riskfor social isolation...I knew something just didn't sound right with that diagnosis.

Thank you so much, Athena! :bowingpur

[augigi, CNS]

Does that mean having an apartment complex for the aged constitutes social isolation??

[RNfromMN, BSN, RN]

My textbook lists "desire to exist in a subculture" as a defining characteristic of social isolation. A senior apartment complex would be a "subculture," wouldn't it:confused: ???

(BTW, thanks for the feedback, Augigi - sorry for the late reply...I didn't get the email notification until just now)

[Daytonite, BSN, RN]

hi, jessica 392!

now, you had to have known that at some point i would have joined this discussion as i specifically look for care plan questions. first off, your diagnostic statement doesn't sound right to me. all the elements aren't fitting together correctly.

i'm looking at my copy of nursing diagnoses: definitions & classification 2005-2006 published by nanda international at the nursing diagnosis social isolation on pages 183 and 184 and this is what is has to say:"definition: aloneness experienced by the individual and perceived as imposed by others as a negative or threatening state. related factors [causes] are alterations in mental status, inability to engage in satisfying personal relationships, unaccepted social values, unaccepted social behavior, inadequate personal resources, immature interests, factors contributing to the absence of satisfying personal relationships, alterations in physical appearance and altered state of wellness."

now, i understand that you are attempting to make this apply to a community. however, your "related to" items following your nursing diagnosis "conditions associated with aging (including depression, dementia, hearing loss & incontinence)" sound more like defining characteristics, or symptoms, of the diagnosis (which i am listing below) than they do the causes of it. now, if you were to say "alterations in mental status and physical wellness" i think your diagnostic statement would be more accurately phrased since that wording reflects the cause of the social isolation.

remember also, that all items following your "as manifested by" part of the diagnostic statement must contain your assessment data that led to, and supports, your nursing diagnosis. so, your items of "depression, dementia, hearing loss and incontinence" wound belong there since these would be symptoms supporting the diagnosis.

problem: i think you need a bit more specificity with the depression, dementia, hearing loss and incontinence. how many are affected and can you show a direct link to the social isolation as the cause for these things? can you show that hearing loss is due to social isolation? i think i know what you are getting at by saying "hearing loss", i'm just wondering if you are calling it by it's correct label.

here are some of the items that are listed in my above reference as the defining characteristics, or symptoms, for this diagnosis: "absence of supportive significant others i.e. family, friends, groups; the person projects hostility in voice and behavior, withdrawn, uncommunicative, shows behavior unaccepted by dominant cultural group, seeks to be alone or exists in a subculture, repetitive meaningless actions, preoccupation with ones own thoughts, no eye contact, inappropriate or immature activities for developmental age/stage, evidence of physical/mental handicap or altered state of wellness, sad dull affect, expresses feelings of aloneness imposed by others, expresses feelings of rejection, inability to meet expectations of others, expresses values acceptable to the subculture but unacceptable to the dominant cultural group, experiences feelings of differences from others, insecurity in public." did you observe any of this in the clients of your community?

with regard to outcomes, they must be the predicted results of our independent nursing actions. in addition, by definition they must be measurable. if they are not measurable, what can you compare them with to declare that they have been achieved? so, look to the predicted results of your nursing interventions to give you your outcomes. the whole care plan process is one big cycle that is all interrelated.

by the way, i like your use of color and bold-facing!

[RNfromMN, BSN, RN]

Daytonite- I had beautiful responses to your feedback (thank you so much, BTW), tried to post them twice and they got erased each time :Crash:

I'm on my way to school now, but I'll be back tonight...just wanted to let you know that I'm working on it...I didn't take the money (your advice) & run :monkeydance:

[Daytonite, BSN, RN]

F.Y.I. . .I only have dial up service and I get disconnected all the time. I compose, or at least copy and paste every single post before I press the "Submit Reply" or "Preview Post" buttons onto a blank Word document that I keep open at all times. That way, if some tragedy befalls, which can happen, I still have the work to copy onto a new attempt at replying. When I'm replying to care plan questions, I'm often working on the answers for an hour on open Word document because I'm looking through my books here at home. If I lost all my text I'd be more than upset. The only problems I have doing this is that the allnurses software seems to want to turn some of my cut and pasted text into Ariel font for some reason. That, however, is easily remedied.